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Almost everyone who has a traumatic limb amputated will experience a phantom limb - the vivid impression that the limb not only still is present, but also in many cases, painful. Preliminary data from study WRAMC WU# 05-71034, "Pilot study to assess the efficacy of mirror-box and mental visualization treatments on phantom limb pain" demonstrates that 4 weeks of mirror therapy is effective for treating phantom limb pain (PLP) and suggests that vision is a key component modulating PLP and may be the explanation for the efficacy of mirror therapy, as subjects view the reflected image of their intact limb while attempting to move the amputated, or phantom, limb. We propose conducting a study using functional magnetic resonance imaging (fMRI) to identify brain regions critical for the mirror effect and to study the relationship of visual activation to the sensation of phantom pain. Subjects will have an fMRI scan prior to starting therapy, 2 weeks after starting mirror therapy and again after 4 weeks of mirror therapy. Data will be gathered daily on the number of episodes of phantom limb pain, the average length of episodes, and the average intensity of pain.

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Ages Eligible for Study:

18 Years to 75 Years (Adult, Senior)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Criteria

Inclusion Criteria:

For Amputee Subjects:

Male or female subjects

18 to 75 years of age

Active duty military

Military healthcare beneficiary

Military retiree

Written informed consent and written authorization for use or release of health and research study information

Unilateral lower limb amputation

Right-handed

Any level of prosthetic experience

No prior history of vertebral disk disease/condition

Sciatica

Radiculopathy

Neurological examination that will not interfere with participation in the study

Minimum of 3 phantom limb pain episodes each week

Degree of pain evaluated by VAS scoring a minimum of 3 cm at time of screening for entry into study.

Ability to follow study instructions and likely to complete all required visits

For Control Subjects:

Male or female subjects

18 to 75 years of age

Written informed consent and written authorization for use or release of health and research study information

Right-handed.

No prior history of vertebral disk disease/condition

Sciatica

Radiculopathy

Normal neurological examination

Ability to follow study instructions and likely to complete all required visits

Exclusion Criteria:

For Amputee Subjects:

Age less than 18 or greater than 75 years

Unilateral upper limb or multiple limb amputation.

Amputation due to diabetes or vascular claudication

No known pending revision surgeries

Presence of embedded metallic shrapnel or other metal not compatible with MRI scanning

Presence of traumatic brain injury - permanent or temporary impairments of cognitive, physical, and psychosocial functions with an associated diminished or altered state of consciousness - as indicated by neuropsychological screening, including DVBIC testing, which is currently performed routinely on patients by the TBI program at WRAMC and noted in the patient's medical record

Known uncontrolled systemic disease- known cancer not in remission

Known on-going infection

Lupus

Kidney disease requiring dialysis, any other systemic disease which might affect ability to participate in this study to its conclusion

Concurrent participation in another investigational drug or device study for phantom limb pain or participation in the 30 days immediately prior to study enrollment

Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study

Significant Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study

Subjects with lack of effort as determined by the neurologist or physiatrist

Subjects will be screened for effort using the Test of Memory Malingering (TOMM) first in order to exclude those with blatant exaggeration or malingering

For Control Subjects:

Age less than 18 or greater than 75 years

Presence of an amputation

Presence of embedded metallic shrapnel or other metal not compatible with MRI scanning

Presence of traumatic brain injury - permanent or temporary impairments of cognitive, physical, and psychosocial functions with an associated diminished or altered state of consciousness - as indicated by neuropsychological screening which is currently performed routinely on patients by the TBI program at WRAMC and noted in the patient's medical record

Known uncontrolled systemic disease- known cancer not in remission

Known on-going infection

Lupus

Kidney disease requiring dialysis

Any other systemic disease which might affect ability to participate in this study to its conclusion

Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study

Significant Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study